OPS FISCAL ASSISTANT II - 64858601

Requisition No: 843731 

Agency: Department of Health

Working Title: OPS FISCAL ASSISTANT II - 64858601

 Pay Plan: Temp

Position Number: 64858601 

Salary:  $20.58 Hourly 

Posting Closing Date: 01/06/2025 

Total Compensation Estimator Tool

FLORIDA DEPARTMENT OF HEALTH BROWARD COUNTY

OPS FISCAL ASSISTANT II - 64906958

ACCOUNTANT & FINANCE

OPEN COMPETITIVE OPPORTUNITY

This position requires you to work on site at one of our facilities located throughout Broward County.

This is an OPS (Other Personal Services) positions and as such no paid time off is offered. Health benefits will be offered for full-time employment.  OPS employees are eligible to participate in a deferred compensation plan.

 We request that all applications be completed with People First - no faxed or mailed applications to the agency. Experience, education, and/or training used to meet the minimum qualifications and in response to the qualifying questions must be verifiable through information contained in your application.

When completing the online application, all gaps of employment or education greater than 90 days starting from high school must be explained (approximate date, month, and year) identifying company name or if unemployed. Incomplete applications will not be considered.

DUTIES :
Claims Denial, Appeals, and Collections
Accurately audit the medical EOBs (Explanation of Benefits) for inappropriate reimbursement, denied, delayed, or partially paid
claims. Corroborate reversal of the insurance plan determination through the claim's appeals process according to the
insurance plan's provider handbook. Maintain an insurance follow-up log of claims appeals. Run accounts receivable report in
HMS (Health Management System) by insurance company to keep track of the claims aging process. Follow-up in writing or by
phone call with insurance plans to assure collections of incorrectly denied or partially paid claim. Accurately post and document
in HMS the denied claims and partial payments. At last resort, file a complaint in the AHCA's (Agency for Health Care
Administration) complaint hub only with the written approval from your supervisor.

Responsible for the accuracy and timeliness of medical billing to all insurance companies. Capture the correct charge for every
service provided. Prevent denials of claims. Performs all the necessary tasks in HMS billing portal to ensure appropriate
reimbursement. Sample of the billing tasks in HMS to include the following, but not limited: Records a Service, Mark & Bill
Service, Service Description Maintenance, Bill File Creation, Bill File Fix, Import Electronic Billing Records, print hardcopies of
CMS1500 and ADA and send to insurance company, and Insurance Company File maintenance, etc.

Claims and Billing Audit and Quality Assurance:
Responsible for the daily audit and quality assurance of all the dental and medical claims for all the dental and medical clinics at
Broward County Health Department. Daily, employee will audit all the encounters for dental & medical services to ensure
appropriate and correct billing. The duties include the following: review each service encounter against the electronic health
record for dental and medical services; insure appropriate CDT, CPT and ICD-10 have been correctly assigned; verify the
Medicaid & Medicare plan in FMMIS (Florida Medicaid Management Information Systems) and/or Change Healthcare systems;
review and ensure the appropriate payor source has been captured in HMS; correct all errors in HMS for appropriate billing;
inform and training the clinic staff making the errors; follow up on the each claim via the Insurance Plan's web portal; capture all
the claims statistics in Excel including no-show rate; submit reports to supervisor on a weekly basis.
Payment Posting:
Responsible for the posting in HMS all the Explanation of Benefits (EOB) from the insurance companies. Ensure reimbursement
amount from the insurance companies is the correct allowable amount. Sample of the posting tasks in HMS to include the
following, but not limited: Create Voucher, Post Voucher Payment, and Reconcile Voucher. Review and process the unbilled
claims daily.

Assist in Training of Data Entry Process:
Assist in the training of Dental SBS/ Dental WIC Fluoride date entry process of new employees. Assist with FMMIS training. Assist
in re-training of HMS basics such as demographics, label printing, insurance update, record services, mark and bill and attach
documents.
 

MINIMUM QUALIFICATIONS

1. Are you willing to work before, during and/or beyond normal work hours, or days in the event of an emergency? Additionally, emergency duties are inclusive of working in Special Needs Shelters, or performing other emergency duties, but not limited to responses to or threats involving any disaster, man-made or natural.
2. Data entry experience.
3. Experience conducting medical/dental insurance eligibility.
4.  A minimum of (1) one-year customer service experience in a clerical/cashier position within the past three years.

PREFERRED QUALIFICATIONS

1. A minimum of (2) two years health insurance claims processing experience within the past three years.
2. Associates degree or higher in finance, accounting, business administration from an accredited college or university.
3. Current certification as a Certified Professional Coder (CPC).

Florida Department of Health Mission, Vision, and Values:

Mission:

To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.

Vision:

To be the Healthiest State in the Nation.

Values:

I nnovation: We search for creative solutions and manage resources wisely.

C ollaboration: We use teamwork to achieve common goals & solve problems.

A ccountability: We perform with integrity & respect.

R esponsiveness: We achieve our mission by serving our customers & engaging our partners.

E xcellence: We promote quality outcomes through learning & continuous performance improvement.

The Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. As an OPS employee, the benefits below are available:

• State of Florida 401(a) FICA Alternative Plan (mandatory)
• Participation in state group insurance (upon meeting eligibility requirements.  Consult with People First and/or the serving HR office)
• Workers’ Compensation (mandatory, if needed)
• Reemployment Assistance (Unemployment Compensation) (mandatory, if needed)
• Deferred Compensation (voluntary)
• Employee Assistance Program (voluntary)
• And more!

For a more complete list of benefits, including monthly costs, visit www.mybenefits.myflorida.com.

Please be advised:

Your responses to qualifying questions for this position must be verifiable by documentation provided through the electronic application process.  

This position requires a security background check and/or drug screening and participation in direct deposit. Any misrepresentations or omissions will disqualify you from employment consideration. Note: You will be required to provide your Social Security Number (SSN) in order to conduct this background check Successful completion of a drug test is a condition of employment for safety-sensitive positions.

Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Services System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from the SSS. For more information, please visit the SSS website: http://www.sss.gov 

If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida.  Your current retirement benefits may be canceled, suspended or deemed ineligible depending upon the date of your retirement. 

The successful candidate will be required to complete the Form I-9 and that information will be verified using the E-Verify system.  E-Verify is operated by the Department of Homeland Security in partnership with the Social Security Administration to verify employment eligibility.   

Incumbents may be required to perform emergency duty before, during, and/or beyond normal work hours or days.

Applicants requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-877-562-7287). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation. 

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act. 

Florida has the third largest population of veterans in the nation with more than 1.5 million service men and women.  The Florida Department of Health (department) is committed to serving members of the United States Armed Forces, veterans and their families by encouraging them to apply for vacancies that fit their area of knowledge and/or expertise.  Through the Department's VALOR program, which expedites licensing for military veterans, the Department also waives initial licensing and application fees for military veterans who apply for a health care professional license within 60 months of an honorable discharge. These initiatives help ensure that the transition from military service into the workforce is as smooth as possible and reflects our appreciation for the dedication devoted to protecting our country.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.